Publications by authors named "Anne M Lynch"

81 Publications

The Protective Effect of Metformin Use on Early Nd:YAG Laser Capsulotomy.

Invest Ophthalmol Vis Sci 2021 Aug;62(10):24

Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, United States.

Purpose: To determine the effect of metformin on early Nd:YAG laser treatment for posterior capsule opacification (PCO) and to explore a molecular mechanism to explain a possible protective effect of metformin against PCO.

Methods: We conducted: 1) a retrospective cohort study of patient eyes undergoing phacoemulsification at our institution; and 2) laboratory investigation of the effect of metformin on the behavior of lens epithelial cells in the context of an animal model for PCO. Population-averaged Cox proportional hazards modeling was used to estimate risk for time to Nd:YAG. For laboratory studies, expression of markers for epithelial-to-mesenchymal transition (EMT) implicated in PCO pathogenesis was measured in tissue culture and following extracapsular lens extraction in a mouse model.

Results: The rate of Nd:YAG laser capsulotomy was 13.1% among the 9798 eyes. Both metformin use and diabetes were protective factors for Nd:YAG laser capsulotomy in univariate analysis. However, in multivariable analysis with nondiabetics as the reference group, only metformin use among diabetics was significantly protective of Nd:YAG (hazard ratio: 0.68, 95% CI: 0.54-0.85, P = 0.0008), while eyes of patients with diabetes without metformin use did not significantly differ (P = 0.5026). Treatment of lens epithelial cells with metformin reduced the level of the EMT markers ⍺-SMA and pERK induced by TGF-β2. Similarly, metformin treatment reduced ⍺-SMA expression in lens epithelial cells following extracapsular lens extraction in a mouse model.

Conclusions: The protective effect of metformin against early Nd:YAG may relate to its ability to downregulate EMT in residual lens epithelial cells that otherwise trend toward myofibroblast development and PCO.
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http://dx.doi.org/10.1167/iovs.62.10.24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8383914PMC
August 2021

Timing of Quiescence and Uveitis Recurrences After Cataract Surgery in Patients with a History of Uveitis.

Ophthalmol Ther 2021 Sep 23;10(3):619-628. Epub 2021 Jun 23.

Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Ct, F731, Aurora, CO, 80045, USA.

Introduction: In patients with a history of uveitis, a 60-90-day period of quiescence prior to cataract surgery has been historically recommended. These recommendations were based mostly on expert opinion. The purpose of this study was to further examine and understand uveitis quiescence timing and outcomes of eyes that do have a recurrence of uveitis after cataract surgery.

Methods: Patients with a history of uveitis undergoing cataract surgery at the University of Colorado Sue-Anschutz Rodgers Eye Center from 2014 to 2018 were studied. Main outcome measures were best corrected visual acuity (BCVA) at 6 months, intraocular pressure (IOP) at 6 months, and recurrences of uveitis within 90 days of surgery. Timing of cataract surgery in relation to preoperative uveitis quiescence was recorded.

Results: A total of 149 eyes from 114 patients were included. Uveitis recurrence was seen in 31 (20.8%) of the 149 eyes with a history of uveitis undergoing phacoemulsification. The mean logMAR change or improvement in vision was 0.429 in eyes with a recurrence of uveitis, and 0.318 in eyes without, a difference that was not statistically significant (p = 0.292). Eyes with a recurrence of uveitis displayed higher IOP at 6 months compared to eyes without a recurrence, at 16.1 versus 13.0 mmHg respectively (p = 0.0009). Eyes that were quiescent for 30 days or less were more likely to have a uveitis recurrence (OR 6.11, 95% CI 2.48-15.06, p = 0.0001).

Conclusions: Our study shows that a quiescence period of at least 30 days is beneficial in reducing uveitis recurrence after cataract surgery. It is unclear what the long-term consequences of a uveitis recurrence after cataract surgery are, though it appears there may be elevated IOP in patients with recurrences, and thus patients with a history of uveitis should be counseled carefully about this potential risk.
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http://dx.doi.org/10.1007/s40123-021-00363-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319284PMC
September 2021

Prior pars plana vitrectomy and its association with adverse intraoperative events during cataract surgery.

Acta Ophthalmol 2021 Jun 16. Epub 2021 Jun 16.

Sue Anschutz-Rodgers UCHealth Eye Centers, Department of Ophthalmology, University of Colorado School of Medicine, Denver, CO, USA.

Purpose: To evaluate the risk of intraoperative complications during cataract surgery in eyes with a prior vitrectomy.

Methods: A retrospective review of data from our cataract surgery registry of all patients undergoing cataract surgery between 2014 and 2018 at the University of Colorado Hospital. Univariate and multivariate analyses were conducted, accounting for intra-patient correlation in subjects who underwent two cataract surgeries. The three main outcomes of interest, zonulopathy, posterior capsule (PC) tears and dropped lens fragments, were analysed for their association with prior pars plana vitrectomy (PPV) and clinical characteristics of patients such as history of prior intravitreal injection and surgeon level of experience.

Results: 10 540 eyes of 6447 patients were included in the analysis. 371 (3.5%) eyes had a prior PPV. Eyes with a prior PPV experienced more zonulopathy during cataract surgery (adjusted OR 2.2, 95% confidence interval: 1.3-3.7, p = 0.002). Combined phacoemulsification/PPV were significantly more likely to experience all 3 complications, and this effect was even greater for eyes with a prior PPV.

Conclusions: All complications were rare; however, there was a significant association with prior PPV and intraoperative zonulopathy. Cataract surgeons must be aware of a patient's prior vitrectomy and plan accordingly for the increased risk of intraoperative complications.
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http://dx.doi.org/10.1111/aos.14947DOI Listing
June 2021

Iris manipulation during phacoemulsification: intraoperative and postoperative complications.

Int J Ophthalmol 2021 18;14(5):676-683. Epub 2021 May 18.

Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO 80045, USA.

Aim: To quantify intraoperative and postoperative complications in complex phacoemulsification cataract extraction (phacoemulsification) with iris manipulation compared to non-complex and complex phacoemulsification without iris manipulation.

Methods: All phacoemulsification cases at the University of Colorado between January 1, 2014, and June 30, 2017 were included. Exclusion criteria for the primary outcome of intraoperative complications were planned combination surgery and eyes with less than 28d follow-up. Exclusion criteria for the secondary outcomes of postoperative complications were unplanned additional surgery, and chronic steroid eye drop use prior to surgery. Data including sex, race/ethnicity, surgery length, visual acuity, intraoperative and postoperative complications, and intraocular pressures (IOP) were collected and analyzed utilizing general linear and Logistic regression modeling.

Results: The medical records of 5772 eyes were reviewed (500 complex without iris manipulation, 367 with iris manipulation). The number of any intraoperative complication in the complex with iris manipulation and complex without iris manipulation groups was 15 (4.1%) and 26 (5.2%), respectively, compared to 41 (0.8%) in the non-complex group. Postoperative inflammation was found in 135 (2.8%) non-complex cases, 20 (4.1%) complex cases without iris manipulation, and 20 (5.6%) complex cases with iris manipulation. The adjusted odds ratio of postoperative inflammation in phacoemulsification with iris manipulation compared to non-complex was 2.3 (95%CI: 1.3-4.0, =0.005). The rate of IOP spikes >10 mm Hg was significantly greater in cases with iris manipulation (=0.001).

Conclusion: Complex cases have more intraoperative complications. However, only complex cases with iris manipulation led to increase rates of postoperative inflammation and IOP spikes >10 mm Hg.
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http://dx.doi.org/10.18240/ijo.2021.05.06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077016PMC
May 2021

Differential chromatin binding of the lung lineage transcription factor NKX2-1 resolves opposing murine alveolar cell fates in vivo.

Nat Commun 2021 05 4;12(1):2509. Epub 2021 May 4.

Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Differential transcription of identical DNA sequences leads to distinct tissue lineages and then multiple cell types within a lineage, an epigenetic process central to progenitor and stem cell biology. The associated genome-wide changes, especially in native tissues, remain insufficiently understood, and are hereby addressed in the mouse lung, where the same lineage transcription factor NKX2-1 promotes the diametrically opposed alveolar type 1 (AT1) and AT2 cell fates. Here, we report that the cell-type-specific function of NKX2-1 is attributed to its differential chromatin binding that is acquired or retained during development in coordination with partner transcriptional factors. Loss of YAP/TAZ redirects NKX2-1 from its AT1-specific to AT2-specific binding sites, leading to transcriptionally exaggerated AT2 cells when deleted in progenitors or AT1-to-AT2 conversion when deleted after fate commitment. Nkx2-1 mutant AT1 and AT2 cells gain distinct chromatin accessible sites, including those specific to the opposite fate while adopting a gastrointestinal fate, suggesting an epigenetic plasticity unexpected from transcriptional changes. Our genomic analysis of single or purified cells, coupled with precision genetics, provides an epigenetic basis for alveolar cell fate and potential, and introduces an experimental benchmark for deciphering the in vivo function of lineage transcription factors.
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http://dx.doi.org/10.1038/s41467-021-22817-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096971PMC
May 2021

Association of Systemic Inflammatory Factors with Progression to Advanced Age-related Macular Degeneration.

Ophthalmic Epidemiol 2021 Apr 8:1-10. Epub 2021 Apr 8.

Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA.

Age-related macular degeneration (AMD) is a leading cause of vision loss in the elderly. The role of systemic inflammation in AMD remains unclear specifically in patients with intermediate AMD (iAMD). We sought to determine whether systemic inflammation was associated with future iAMD progression. Combinations of 27 circulating inflammatory markers including complement factors, cytokines, chemokines, and high-sensitivity C-reactive protein (hsCRP) were evaluated in iAMD patients recruited into a Colorado AMD registry. Systemic inflammatory markers were combined using principal component analysis. Risk factors for AMD progression were evaluated using Cox regression models. This study included 99 subjects with iAMD, 21 of which progressed to advanced AMD. Two principal components (PCs) were identified that contributed to the risk of progression to advanced AMD, after adjusting for age and bilateral reticular pseudodrusen. The strongest associated PC was explained largely by the pro-inflammatory cytokine TNFα and the anti-inflammatory IL1ra antagonist of IL1. The additional PC was largely explained by IL6, IL8, C3 and factor D in the positive direction and CRP, MCP1, factor B and factor I in the negative direction. When evaluated through multivariate analyses, combinations of biomarkers distinguished patients who did and did not progress to future advanced AMD. Increased risk could result from different combinations of analyte levels indicating a complex relationship rather than a simple increase in a few markers. This suggests that studying systemic inflammation in iAMD can provide insights into early pathologic events and potentially identify patients at highest risk for the development of severe AMD.
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http://dx.doi.org/10.1080/09286586.2021.1910314DOI Listing
April 2021

Endoscopic Cyclophotocoagulation Combined with Phacoemulsification Increases Risk of Persistent Anterior Uveitis Compared to Phacoemulsification Surgery Alone.

Clin Ophthalmol 2021 5;15:437-443. Epub 2021 Feb 5.

Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.

Purpose: To evaluate if the addition of endoscopic cyclophotocoagulation (ECP) to uncomplicated phacoemulsification cataract extraction increases the risk of persistent anterior uveitis (PAU) compared to phacoemulsification alone.

Patients And Methods: Retrospective analysis of patients who had either phacoemulsification alone or combined with endoscopic cyclophotocoagulation from January 1, 2014 to December 31, 2017. Visual acuity, intraocular pressure, presence of anterior chamber cells, and steroid usage were analyzed pre- and post-operatively. Patient eyes with a history of uveitis, autoimmune disease, complicated cataract surgery, combined surgery other than ECP, and less than 3 months of follow-up were excluded.

Results: This study consisted of 4423 eyes from 2903 patients, meeting the inclusion criteria (phacoemulsification only group n=4242 and phacoemulsification/ECP group n=181 eyes). PAU developed in 14.9% in the phacoemulsification with ECP group compared to 1.7% who had phacoemulsification alone. White patients had a 17.9 (95% CI: 7.8-41.1, p<0.0001) increased odds of developing persistent anterior uveitis with a combined procedure compared to phacoemulsification only, while Non-white patients had a 5.8 (95% CI: 2.8-12.1, p<0.0001) increased odds. Despite the higher odds ratio in White patients, this group had a significantly lower rate of PAU compared to Non-white patients after phacoemulsification/ECP.

Conclusion: The addition of endoscopic cyclophotocoagulation to phacoemulsification significantly increases the risk of developing PAU in the post-operative period compared to phacoemulsification alone.
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http://dx.doi.org/10.2147/OPTH.S294791DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873618PMC
February 2021

Accuracy of Intraoperative Aberrometry, Barrett True-K With and Without Posterior Cornea Measurements, Shammas-PL, and Haigis-L Formulas After Myopic Refractive Surgery.

J Refract Surg 2021 Jan;37(1):60-68

Purpose: To assess the accuracy of intraoperative aberrometry, the Barrett True-K No History (Barrett TKNH), Barrett TKNH with posterior corneal measurements (Barrett TKNH with PC), Shammas-PL, and Haigis-L formulas in patients with cataract who had prior myopic refractive surgery.

Methods: This was a retrospective consecutive case series of patients with prior myopic refractive surgery undergoing cataract extraction. Mean absolute error (MAE) and median absolute error (MedAE) of refraction prediction were compared for each formula. Interactions of each biometry measurement were modeled for each formula to evaluate those with the most significant impact on refraction prediction.

Results: One hundred sixteen eyes of 79 patients were analyzed. MAE was 0.40 ± 0.33 diopters (D) for intraoperative aberrometry and 0.42 ± 0.31 D for the Barrett TKNH, 0.38 ± 0.30 D for the Barrett TKNH with PC, 0.47 ± 0.38 D for the Shammas-PL, and 0.56 ± 0.39 D for the Haigis-L formulas. Comparisons between formulas were significant for Barrett TKNH versus Barrett TKNH with PC formulas (P = .046), Barrett TKNH with PC versus Shammas-PL formulas (P = .023), and for all comparisons with the Haigis-L formula (P < .001), and not significant for all other comparisons (P > .05). Eyes were within ±0.50 D of prediction 73%, 72%, 69%, 62%, and 52% of the time for intraoperative aberrometry, the Barrett TKNH with PC, Barrett TKNH, Shammas-PL, and Haigis-L formulas, respectively. Corneal asphericity (Q value) was significantly associated with prediction error for all five methods. Changes in anterior chamber depth had a significant impact on Shammas-PL prediction errors.

Conclusions: Newer technology using information from the posterior cornea modestly improved outcomes when compared to established methods for intraocular lens selection in eyes that had previous laser refractive surgery for myopia. [J Refract Surg. 2021;37(1):60-68.].
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http://dx.doi.org/10.3928/1081597X-20201030-02DOI Listing
January 2021

The impact of advanced age-related macular degeneration on the National Eye Institute's Visual Function Questionnaire-25.

Acta Ophthalmol 2020 Dec 30. Epub 2020 Dec 30.

Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.

Purpose: To assess visual function among patients diagnosed with age-related macular degeneration (AMD) by stage of disease and laterality.

Methods: This is a cross-sectional cohort study of 739 AMD patients and their responses to the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) at time of study enrolment. Patients with AMD were categorized into Early/Intermediate AMD and three groups of advanced AMD: (i) neovascular AMD (NV), (ii) geographic atrophy (GA) and (iii) Both Advanced forms. These three advanced stages were further stratified into unilateral or bilateral advanced disease. Mean composite scores and subscale scores for 12 different areas were based on a 100-point scale with the lowest and highest possible scores set at 0 and 100, respectively. Scores for the advanced AMD groups were compared with Early/Intermediate AMD using general linear modelling.

Results: A total of 739 AMD patients (294 Early/Intermediate, 115 GA, 168 NVAMD and 162 Both Advanced) were included in the analysis. Mean composite scores were highest among Early/Intermediate patients (89.9), followed by patients diagnosed with unilateral disease in the Both Advanced (88.0) and NV (86.1) groups. Mean composite scores were similar for bilateral NV (82.9) and unilateral GA (81.7), and mean scores were lowest for the bilateral GA (71.3) and bilateral Both Advanced (68.5) groups. In general, this pattern persisted across the twelve subscales as well. Subscale scores ranged from a low of 35.1 for driving among bilateral Both Advanced patients to a high of 99.2 for colour vision among patients with unilateral Both Advanced. Overall, patients with unilateral advanced disease consistently had higher mean scores than their bilateral counterparts. The largest difference was 19.5 composite score points between the unilateral and bilateral Both Advanced groups, there was a difference of 10.4 points between the GA groups, and a relatively small difference of 3.2 points between the NV groups.

Conclusions: We found large differences in visual function as reported from the VFQ-25 across the different types of advanced stage AMD groups and number of eyes affected with advanced AMD. These findings demonstrate the importance of accounting for the type and number of eyes affected by advanced stage AMD.
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http://dx.doi.org/10.1111/aos.14731DOI Listing
December 2020

Cataract Surgery Outcomes in Human Immunodeficiency Virus Positive Patients at a Tertiary Care Academic Medical Center in the United States.

Ophthalmic Epidemiol 2020 Dec 28:1-8. Epub 2020 Dec 28.

Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA.

: To compare cataract surgery complications and visual outcomes in patients with and without human immunodeficiency virus (HIV).: A retrospective cohort study was conducted on eyes undergoing phacoemulsification cataract surgery at an academic eye center from 1/1/2014 to 8/31/18. Outcomes included best corrected distance visual acuity (CDVA), intraoperative complications, cystoid macular edema (CME), and persistent anterior uveitis (PAU). Binary outcomes were analyzed using logistic regressions with generalized estimating equations. Visual outcomes were analyzed using a linear mixed model.: 9756 eyes from 5988 patients were included in the analysis. Of these, 66 eyes from 39 patients were HIV positive (HIV+). HIV+ patients were significantly younger at the time of surgery than HIV negative patients ( < .0001). Among HIV+ patients with available lab data, the mean CD4 count was 697.3 (SD = 335.7), and 48.7% of subjects had an undetectable viral load. Five eyes from three HIV+ patients had a history of cytomegalovirus retinitis (CMVR). Positive HIV status was not associated with increased risk of intraoperative complications. Post-operative CDVA was better in the HIV negative group compared to the HIV+ group but not significantly different (about 20/24 vs. 20/28, = .0829). Eyes from HIV+ patients were at increased risk of developing PAU after surgery (adjusted OR = 6.04, 95% CI: 2.42-15.1, = .0001), as well as CME (adjusted OR = 3.25, 95% CI: 1.02-10.4, = .0470).: Eyes from HIV+ patients were at greater risk of developing PAU and clinically significant CME; however, HIV+ patients had similar CDVA after cataract surgery compared to HIV negative patients.
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http://dx.doi.org/10.1080/09286586.2020.1866021DOI Listing
December 2020

Interferon Gamma Mediates Hematopoietic Stem Cell Activation and Niche Relocalization through BST2.

Cell Rep 2020 12;33(12):108530

Section of Infectious Disease, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; Program in Immunology, Baylor College of Medicine, Houston, TX 77030, USA; Program in Developmental Biology, Baylor College of Medicine, Houston, TX 77030, USA; Dan L. Duncan Cancer Center and Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX 77030, USA. Electronic address:

During chronic infection, the inflammatory cytokine interferon gamma (IFNγ) damages hematopoietic stem cells (HSCs) by disrupting quiescence and promoting excessive terminal differentiation. However, the mechanism by which IFNγ hinders HSC quiescence remains undefined. Using intravital 3-dimensional microscopy, we find that IFNγ disrupts the normally close interaction between HSCs and CXCL12-abundant reticular (CAR) cells in the HSC niche. IFNγ stimulation increases expression of the cell surface protein BST2, which we find is required for IFNγ-dependent HSC relocalization and activation. IFNγ stimulation of HSCs increases their E-selectin binding by BST2 and homing to the bone marrow, which depends on E-selectin binding. Upon chronic infection, HSCs from mice lacking BST2 are more quiescent and more resistant to depletion than HSCs from wild-type mice. Overall, this study defines a critical mechanism by which IFNγ promotes niche relocalization and activation in response to inflammatory stimulation and identifies BST2 as a key regulator of HSC quiescence. VIDEO ABSTRACT.
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http://dx.doi.org/10.1016/j.celrep.2020.108530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816211PMC
December 2020

Comparison of refractive prediction for intraoperative aberrometry and Barrett True K no history formula in cataract surgery patients with prior radial keratotomy.

Acta Ophthalmol 2021 Sep 30;99(6):e844-e851. Epub 2020 Nov 30.

Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA.

Purpose: To compare prediction errors of the Barrett True K No History (Barrett TKNH) formula and intraoperative aberrometry (IA) in eyes with prior radial keratotomy (RK).

Methods: A retrospective, non-randomized study of all patients with RK who underwent cataract surgery using IA at the UCHealth Sue Anschutz-Rodgers Eye Center from 2014 to 2019 was conducted. Refraction prediction error (RPE) for IA and Barrett TKNH was compared. General linear modelling accounting for the correlation between eyes was used to determine whether absolute RPE differed significantly between Barrett TKNH and IA. Outcome by number of RK cuts was also compared between the two methods.

Results: Forty-seven eyes (31 patients) were included. The mean RPEs for Barrett TKNH and IA were 0.04 ± 0.92D and 0.01 ± 0.92D, respectively, neither was significantly different than zero (p = 0.77, p = 0.91). The median absolute RPEs were 0.50D and 0.48D, respectively (p = 0.70). The refractive outcome fell within ± 0.50D of prediction for 51.1% of eyes with Barrett TKNH and 55.3% with IA, and 80.8% were within ± 1.00D for both techniques. Mean absolute RPE increased with a higher number of RK cuts (grouped into < 8 cuts and ≥ 8 cuts) for both Barrett TKNH (0.35D and 0.74D, p = 0.008) and IA (0.30D and 0.80D, p = 0.0001).

Conclusions: There is no statistically significant difference between Barrett TKNH and IA in predicting postoperative refractive error in eyes with prior RK. Both are reasonable methods for choosing intraocular lens power. Eyes with more RK cuts have higher prediction errors.
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http://dx.doi.org/10.1111/aos.14688DOI Listing
September 2021

Cost comparison of different treatment approaches of dacryocystitis and dacrocystocele.

Ther Adv Ophthalmol 2020 Jan-Dec;12:2515841420926288. Epub 2020 Oct 9.

Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court F731, Aurora, CO 80045, USA.

Purpose: Congenital dacrocystocele with potential for dacryocystitis are common ophthalmic findings in children. There are multiple surgical approaches to open the mucocele. In this study, we look at the financial impact of these different approaches.

Methods: A retrospective chart review of 17 patients with dacrocystocele or dacryocystitis was performed. We examined four approaches: (1) bedside nasal endoscopy with marsupialization of nasolacrimal duct (NLD) cyst, (2) surgically performed nasal endoscopy with marsupialization of NLD cyst, (3) NLD probe, and (4) a combination of procedures. Cost of the procedure and length of anesthesia were collected. Reoccurrence of symptoms and disease post-procedure were also collected.

Results: The lowest cost billed procedure was bedside nasal endoscopy performed by an otolaryngologist (US$435;  = 1). A nasal endoscopy ( = 2) performed in the operating room (OR) had an average OR fee of US$14,557 [standard deviation (SD): US$7598] for 108.5 (SD: 87.0) min of operating time. An NLD probe ( = 5) performed by pediatric ophthalmologists resulted in an average OR fee of US$5540 (SD: US$1752) for 31.0 min (SD: 8.6 min) of operating time. A combination of both nasal endoscopy and NLD probing ( = 9) had an average OR fee US$10,325 (SD: US$4137) for 69 min (SD: 34.5 min) of operating time.

Conclusion: This is the first study looking at cost benefit of four different approaches to treating dacrocystoceles/dacryocystitis. A NLD probe was a low-cost OR intervention and had the shortest operating time. The combination procedure was more cost-effective than nasal endoscopy or NLD probing alone.
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http://dx.doi.org/10.1177/2515841420926288DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550943PMC
October 2020

Plasma Biomarkers of Reticular Pseudodrusen and the Risk of Progression to Advanced Age-Related Macular Degeneration.

Transl Vis Sci Technol 2020 09 11;9(10):12. Epub 2020 Sep 11.

Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.

Purpose: To determine, using an aptamer-based technology in patients with intermediate age-related macular degeneration (AMD), (1) if there is a difference in plasma levels of 4979 proteins in patients with and without reticular pseudodrusen (RPD), and (2) if plasma levels of proteins are related to time to conversion to advanced AMD.

Methods: Patients with intermediate AMD and RPD were identified from an AMD registry. Relative concentrations of each protein were log (base 2) transformed and compared between patients with and without RPD using linear regression. A Cox proportional hazards survival model was fit to each aptamer to quantify associations with time to conversion. A pathway analysis was conducted in converters versus non-converters using the Reactome database.

Results: Of the 109 intermediate AMD patients, 39 had bilateral RPD (36%). Two proteins, TCL1A and CNDP1, were lower in patients in the intermediate AMD group with RPD. Twenty-one patients converted to advanced AMD with a median time to conversion of 25.2 months (range, 2.3-48.5 months) and median follow-up time in non-converters of 26.4 months (range, 0.03-49.7 months). Several proteins (lysozyme C, TFF3, RNAS6, and SAP3) distinguished patients who converted from those who did not convert to advanced AMD. The top conversion pathways included tumor necrosis factors bind their physiological receptors, digestion and absorption, signaling by activin, and signaling by TGF-β family members.

Conclusions: We identified a protein signature related to RPD, as well as to conversion to advanced AMD. The pathway analysis suggests that dysfunction of critical systemic pathways may have links to conversion to advanced AMD.

Translational Relevance: Biomarkers identified in plasma likely reflect systemic alterations in protein expression in patients with intermediate AMD.
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http://dx.doi.org/10.1167/tvst.9.10.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488626PMC
September 2020

Association of Federal Regulations in the United States and Canada With Potential Corneal Donation by Men Who Have Sex With Men.

JAMA Ophthalmol 2020 11;138(11):1143-1149

Department of Ophthalmology, University of Colorado School of Medicine, Aurora.

Importance: Federal policy in the United States prohibits corneal donation by men who have had sex with another man (MSM) in the preceding 5 years, whereas Canada enforces a 12-month ban. The potential consequences of these policies on corneal donations should be evaluated.

Objective: To estimate the number of potential corneal donations associated with MSM deferral policies in the United States and Canada.

Design, Setting, And Participants: A nonvalidated telephone survey study was conducted of all 65 eye banks in the United States and Canada to investigate how many potential corneal donors were disqualified in 2018 because of federal MSM restrictions. Published demographic data were also used to arrive at a separate estimate. Survey data were gathered from May 2019 to February 2020.

Main Outcomes And Measures: Eye banks were asked if they keep records of referrals disqualified specifically because of the federal MSM restrictions and, if so, how many referrals they disqualified in 2018 owing to MSM status.

Results: Fifty-four of 65 eye banks (83%) responded to the survey, with 30 eye banks reporting they do not keep specific records of MSM deferrals. The remaining 24 eye banks reported disqualifying 360 referrals in 2018 because of MSM status, equating to 720 corneas. The 24 eye banks accounted for 46.2% of corneal donations in the United States and Canada in 2018, yielding an estimate of approximately 1558 corneas rejected that year because of MSM status. A separate estimate using published MSM demographic data indicates that up to 3217 potential corneal donations may have been disqualified in 2018 because of these federal policies.

Conclusions And Relevance: Findings suggest that between 1558 and 3217 corneal donations were disqualified in 2018 because of federal regulations prohibiting corneal donation by men who have had sex with another man in the preceding 5 years in the United States or 1 year in Canada. With modern virologic testing that is reliable within days of HIV exposure and given the global shortage of corneal tissue, these policies should be reevaluated using current scientific evidence to increase the availability of vision-restoring surgery worldwide.
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http://dx.doi.org/10.1001/jamaophthalmol.2020.3630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7516798PMC
November 2020

Complement Activation in the Vitreous of Patients With Proliferative Diabetic Retinopathy.

Invest Ophthalmol Vis Sci 2020 09;61(11):39

Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, United States.

Purpose: A growing body of evidence points to complement dysregulation in diabetes. Early studies have indicated the presence of complement components inside the eye in patients with diabetic retinopathy, but these data have been confounded by leakage of proteins from the systemic circulation into the vitreous cavity.

Methods: We took samples of plasma and vitreous from patients with and without proliferative diabetic retinopathy (PDR) and measured levels of 16 complement components as well as albumin. We employed a normalized ratio using local and systemic complement and albumin levels to control for vascular leakage into the vitreous cavity.

Results: Before normalizing, we found significantly higher levels of 16 complement components we measured in PDR eyes compared to controls. After normalizing, levels of C4, factor B, and C5 were decreased compared to controls, while C3a and Ba levels were elevated compared to controls. We also found higher ratios of C3a/C3, C5a/C5, and Ba/factor B in PDR eyes compared to controls.

Conclusions: We found evidence of local, intraocular activation of C3, C5, and factor B. The normalized data suggest involvement of the alternative complement pathway. By showing activation of specific complement components in PDR, this study identifies targets for diagnostic and therapeutic potential.
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http://dx.doi.org/10.1167/iovs.61.11.39DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520707PMC
September 2020

Trends in Retinopathy of Prematurity over 12 Years in a Colorado Cohort.

Ophthalmic Epidemiol 2021 Jun 7;28(3):220-226. Epub 2020 Sep 7.

Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.

Purpose: To determine trends in retinopathy of prematurity (ROP) in a Colorado cohort between 2006 and 2017 and compare trends in risk factors between our cohort and statewide data.

Methods: A retrospective cohort study was conducted by the use of records from two registry databases: 1) an academic center's ROP registry, and 2) vital statistics birth data from the Colorado Department of Public Health and Environment (CDPHE). ROP was categorized as severe (type 1 or type 2), low grade (not type 1 or type 2), or no ROP. Other variables included in the analyses were gestational age and birth weight at delivery, and infant mortality. Trends over time were evaluated for both registry databases using generalized linear models.

Results: In our ROP registry cohort of 1,267 eligible infants, 134 (10.6%) developed severe ROP and 279 (22%) developed low-grade ROP. We found no overall trend in severe ROP rates ( = .23), and a decreasing trend in rates of low-grade ROP ( < .01) over the study period. Trends in gestational age, birth weight, and mortality rates remained stable during the study period in both the ROP registry and the CDPHE cohorts.

Conclusion: The rate of severe ROP in our ROP registry cohort did not change over time. There was evidence of a decreasing trend in low grade ROP during the 12-year study period that was not explained by a change in the primary ROP risk factors in either the ROP registry cohort or the Colorado statewide data.
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http://dx.doi.org/10.1080/09286586.2020.1815801DOI Listing
June 2021

What Is the Cost of a Posterior Capsule Rupture Complication?

Ophthalmic Surg Lasers Imaging Retina 2020 08;51(8):444-447

Background And Objective: To examine the cost of a posterior capsule rupture (PCR) in patients who underwent planned phacoemulsification.

Patients And Methods: Retrospective review of 8,113 cataract surgeries performed between January 2014 and December 2017 at one academic institution. The rate of PCR was 0.55%, and 34 patients with PCR who met inclusion criteria were identified. Investigators evaluated the added operating room time required to manage PCR, subsequent surgeon visits beyond the typical average, referrals to other specialties, further imaging, and additional required surgeries.

Results: Patients with PCR had an additional 2.76 (standard deviation [SD] ± 3.27) postoperative encounters and 3.06 (SD ± 3.78) visits to another subspecialty. Operating room time was found to average 61.43 minutes (range: 21 to 191 minutes) at an additional cost of $455.48 (SD ± $407.37). Additional visits, imaging, and procedures added $655.59 (SD ± $767.21). The total additional average cost was $1,111.07 (SD ± $1,021.20) per PCR.

Conclusion: Posterior capsular ruptures impose a substantial cost burden on the health care system. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:444-447.].
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http://dx.doi.org/10.3928/23258160-20200804-04DOI Listing
August 2020

Posterior Capsule Rupture during Cataract Surgery in Eyes Receiving Intravitreal anti-VEGF Injections.

Curr Eye Res 2021 02 23;46(2):179-184. Epub 2020 Jul 23.

Department of Ophthalmology, University of Colorado School of Medicine , Aurora, CO, USA.

Purpose: To examine the risk of posterior capsule rupture (PCR) during phacoemulsification cataract surgery in patients who received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections prior to surgery.

Methods: A retrospective study was conducted of cataract surgeries at the Sue Anschutz-Rodgers UCHealth Eye Center from January 1, 2014, through December 31, 2018. The primary outcome was the occurrence of PCR during surgery. Other variables of interest included age, race, sex, ocular comorbidities, diabetes, mature cataract, primary surgeon, injection frequency and type, and date of most recent injection. Predictors of PCR were assessed using logistic regression with generalized estimating equations to account for correlation between patient eyes. Additional sub-analysis was performed on eyes with PCR with and without anti-VEGF injection history to compare intraoperative characteristics, post-operative complications, and visual outcomes.

Results: In total 10,327 cataract surgeries were included in the analysis, and 308 of these eyes received anti-VEGF injections prior to surgery. Of the 308 eyes that received anti-VEGF injections, eight (2.6%) had a PCR during surgery compared to 45 of 10,019 eyes (0.5%) that did not receive injections (unadjusted OR = 5.9, 95% CI: 2.8-12.7, < .0001). Males and diabetics were more likely to have received injections and had higher rates of PCR, so these variables were adjusted for in the multivariate analysis of the association between injections and PCR (adjusted OR = 4.7, 95% CI: 2.1-10.4, -value = 0.0001). Eyes with mature cataracts and those that underwent surgery with a resident as the primary surgeon were also at higher risk of PCR, but these variables were not associated with the anti-VEGF injection. Injection frequency, time between most recent injection and surgery, and type of anti-VEGF agent were not significantly associated with PCR.

Conclusions: History of intravitreal anti-VEGF injections was associated with higher odds of PCR during cataract surgery.
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http://dx.doi.org/10.1080/02713683.2020.1795884DOI Listing
February 2021

Comparison of Different Surgical Approaches to Inferior Oblique Overaction.

J Binocul Vis Ocul Motil 2020 Jul-Sep;70(3):89-93. Epub 2020 Jun 8.

Department of Ophthalmology, University of Colorado School of Medicine , Aurora, Colorado.

Background: The purpose of this study is to compare surgical outcomes of recession, anteriorization, and myotomy for the treatment of inferior oblique overaction (IOOA).

Methods: A retrospective chart review of all patients undergoing IOOA correction from July 2010 to March 2017 at the Children's Hospital of Colorado was performed. Preoperative grading of IOOA (+0.5 to +4.0) was compared to post-operative IOOA (0 to +4.0). The goal was reduction of IOOA to 0, but any decrease in IOOA was measured.

Results: There were a total of 260 patients with 357 eyes. Gender and age were similar across surgery types. A 94.6% of eyes had a decrease in IOOA with recession (n = 165) of the inferior oblique while 86.1% decreased to no IOOA. Anteriorization of the inferior oblique (n = 115) decreased overaction in 97.4% of eyes with 81.7% improving to zero degree of IOOA. Myotomy of the inferior oblique (n = 77) was found to decrease overaction in 98.7% of eyes and reduce IOOA to zero in 88.3%. There was no significant difference among type of surgery and outcome.

Conclusion: All three surgical interventions were found to be equally successful in reducing the amount of IOOA.
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http://dx.doi.org/10.1080/2576117X.2020.1776566DOI Listing
June 2021

Complement factors and reticular pseudodrusen in intermediate age-related macular degeneration staged by multimodal imaging.

BMJ Open Ophthalmol 2020 14;5(1):e000361. Epub 2020 Jan 14.

Department of Ophthalmology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.

Objective: Systemic activation of the complement system in intermediate age-related macular degeneration (AMD) is understudied. Moreover, links between the presence of reticular pseudodrusen (RPD) and systemic complement dysregulation have not been studied. The aim of this study was to determine if there is a difference in plasma complement factor levels in intermediate AMD compared with controls, and if complement levels are related to the presence of RPD.

Methods And Analysis: Levels of complement factors C1q (µg/mL), C4 (µg/mL), C2 (µg/mL), Mannose Binding Lectin (ng/mL), C4b (µg/mL), C3 (µg/mL), factor B (µg/mL), factor D (µg/mL), properdin (µg/mL), C3a (ng/mL), iC3b/C3b (ng/mL), Ba (ng/mL), factor H (µg/mL), factor I (µg/mL), C5 (µg/mL), C5a (pg/mL) and SC5b-9 (ng/mL) were measured in plasma.

Results: 109 cases and 65 controls were included in the study. Thirty-nine (36%) cases had RPD. Significantly lower systemic levels of: C1q (OR 0.96, 95% CI 0.94 to 0.98), factor B (OR 0.98, 95% CI 0.96 to 0.99), iC3b/C3b (OR 0.97, 95% CI 0.95 to 0.98), factor H (OR 0.99, 95% CI 0.98 to 0.99), factor I (OR 0.83, 95% CI 0.77 to 0.89) and C5 (OR 0.94, 95% CI 0.90 to 0.98) were found in cases versus controls. Significantly elevated levels of: C2 (OR 1.29, 95% CI 1.07 to 1.59), C3a (OR 1.03, 95% CI 1.01 to 1.05) Ba (OR 1.03, 95% CI 1.01 to 1.05) and C5a (OR 1.04, 95% CI 1.02 to 1.07) were found in cases versus controls. Systemic levels of complement factors measured were not related to the presence of RPD.

Conclusions: Levels of several systemic complement pathway factors were found to be altered in intermediate AMD. Systemic levels of complement factors were not related to RPD.
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http://dx.doi.org/10.1136/bmjophth-2019-000361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254108PMC
January 2020

Comparison of Visual Outcomes of Extended Depth of Focus Lenses in Patients With and Without Previous Laser Refractive Surgery.

J Refract Surg 2020 Jan;36(1):28-33

Purpose: To compare visual outcomes of eyes with and without previous laser refractive surgery that received an extended depth of focus intraocular lens during cataract surgery.

Methods: This was a retrospective review of all eyes implanted with an extended depth of focus intraocular lens by two surgeons. Preoperative demographic and eye examination information were collected, as well as postoperative refraction, uncorrected distance visual acuity, and Visual Function Index (VF-14) questionnaire responses. Medical records were reviewed postoperatively to collect the number of patients who required a refractive touch-up or lens exchange.

Results: Most patient eyes (187 of 215, 87%) had no prior refractive surgery, and there was no significant difference in preoperative characteristics between this group and the 28 eyes that did have previous laser refractive surgery. Postoperatively, most patients had a refractive error within ±0.50 diopters (D) (79% without vs 77% with previous laser refractive surgery, P = .40). Although more patients in the group without previous laser refractive surgery achieved 20/20 uncorrected distance visual acuity (UDVA) (56.8% versus 28.6%, P = .01), the majority in both groups achieved 20/25 or better UDVA (79.5% versus 85.7% for without versus with previous laser refractive surgery, P = .42). Postoperative subjective visual function score was also similar between the two groups as measured by the VF-14 questionnaire (86.9 vs 79.4, P = .15). Few patients required refractive surgery enhancement in either group (9 of 187 (4.8%) versus 1 of 28 (3.6%) for without versus with previous laser refractive surgery, P = .77).

Conclusions: The data suggest that extended depth of focus lens implantation can have successful results for patients with prior laser refractive surgery. [J Refract Surg. 2020;36(1):28-33.].
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http://dx.doi.org/10.3928/1081597X-20191204-01DOI Listing
January 2020

Therapeutic challenges in the treatment of systemic inflammatory disease in pregnancy.

Obstet Med 2019 Dec 9;12(4):180-185. Epub 2019 Jan 9.

Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.

Background: Granulomatosis with polyangiitis and Behçet's disease can occur during pregnancy and may be treated by ophthalmologists, rheumatologists, and obstetricians. We hypothesized that specialty training would affect the way physicians selected therapy.

Methods: Using an online questionnaire, 209 uveitis specialists, 853 rheumatologists, and 2500 obstetricians were surveyed. Respondents were given clinical vignettes containing a female patient who was contemplating pregnancy or in the first trimester and was diagnosed with granulomatosis with polyangiitis or Behçet's disease.

Results: In the patient with granulomatosis with polyangiitis, therapy choice between specialties for biologic versus non-biologic systemic immunosuppressive medications was significantly different for both the non-pregnant and pregnant patient (p < 0.00001, p < 0.00003). In the non-pregnant patient diagnosed with Behçet's disease, the therapy choice between biologic versus non-biologic medications was also significantly different (p < 0.0003).

Conclusions: Specialty training affects how physicians manage granulomatosis with polyangiitis and Behçet's disease. Development of inter-specialty guidelines and treatment plans may improve outcomes, communication, and patient care.
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http://dx.doi.org/10.1177/1753495X18819929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909302PMC
December 2019

Hormone Therapy as a Protective Factor for Age-Related Macular Degeneration.

Ophthalmic Epidemiol 2020 04 8;27(2):148-154. Epub 2019 Dec 8.

Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, U.S.A.

: The purpose of this study was to determine if the use of menopausal hormone therapy (HT) is related to the development of neovascular (NV) age-related macular degeneration (AMD), geographic atrophy (GA) and/or early/intermediate AMD.: A case-control study was conducted from patients prospectively recruited from July 2014 to June 2019. Cases were females with AMD recruited into a registry and controls were females with age-related cataract and no AMD. Age-related macular degeneration was categorized into NV-AMD, GA, and early/intermediate. Hormone therapy (historic and current) was self-reported by the patient and categorized as ever/never use. Adjusted odds ratios (ORs) from multinomial logistic regressions are presented for each AMD group.: Female AMD case patients (n = 409) and controls (n = 132) were included in the analytic database. Almost half (45.5%) of the female AMD patients had NV-AMD, 14.9% had GA, and 39.6% had early/intermediate AMD. Among all study participants, 285 (52.7%) reported historic and/or current use of HT. Controls were significantly more likely to have any HT use (71.2%), compared to 43.0% (p ≤ 0.001) of NV-AMD patients, 47.5% ( = .002) of GA patients, and 50.6% (p ≤ 0.001) of early/intermediate AMD patients. Adjusted for potential confounders of age and Caucasian race, cases were significantly more likely to have lower HT use compared to controls: NV-AMD, OR = 0.31 (95%CI: 0.18-0.54), GA, OR = 0.40 (95%CI: 0.20-0.80), and early/intermediate AMD, OR = 0.36 (95%CI: 0.22-0.61).: Our case-control study found that the use of HT was associated with a lower odds of all AMD stages studied: NV-AMD, GA and early/intermediate.
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http://dx.doi.org/10.1080/09286586.2019.1701041DOI Listing
April 2020

Refractive outcomes among glaucoma patients undergoing phacoemulsification cataract extraction with and without Kahook Dual Blade goniotomy.

Eye Vis (Lond) 2019 19;6:28. Epub 2019 Sep 19.

Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court F731, Aurora, CO 80045 USA.

Background: Glaucoma patients undergoing phacoemulsification alone have a higher rate of refractive surprise compared to patients without glaucoma. This risk is further increased with combined filtering procedures. Indeed, there are few and conflicting reports on the effect of combined phacoemulsification and micro-invasive glaucoma surgery (MIGS). Here, we look at refractive outcomes of glaucoma patients undergoing phacoemulsification with and without Kahook Dual Blade (KDB) goniotomy.

Methods: Retrospective chart review of 385 glaucomatous eyes of 281 patients, which underwent either phacoemulsification alone ( = 309) or phacoemulsification with KDB goniotomy ( = 76, phaco-KDB) at the University of Colorado. The main outcome was refractive surprise defined as the difference in target and postoperative refraction spherical equivalent greater than ±0.5 Diopter (D).

Results: Refractive surprise greater than ±0.5 D occurred in 26.3% of eyes in the phaco-KDB group and 36.2% in the phacoemulsification group ( = 0.11). Refractive surprise greater than ±1.0 D occurred in 6.6% for the phaco-KDB group and 9.7% for the phacoemulsification group ( = 0.08). There was no significant difference in risk of refractive surprise when pre-operative IOP, axial length, keratometry or performance of KDB goniotomy were assessed in univariate analyses.

Conclusion: There was no difference between refractive outcomes of glaucomatous patients undergoing phacoemulsification with or without KDB goniotomy.
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http://dx.doi.org/10.1186/s40662-019-0153-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751845PMC
September 2019

Comparison between weight gain and Fenton preterm growth z scores in assessing the risk of retinopathy of prematurity.

J AAPOS 2019 10 11;23(5):281-283. Epub 2019 Sep 11.

Department of Ophthalmology, University of Colorado School of Medicine, Aurora; Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora. Electronic address:

Several studies have shown that postnatal weight gain is a significant predictor for retinopathy of prematurity (ROP) in preterm infants. Using a cohort of 1,301 infants from a single-center ROP registry, we investigated whether incorporation of changes in Fenton preterm growth curve z scores (ie, deviation from the population average) provides improved predictive ability for developing ROP compared to weight gain alone. Three logistic regressions were fit to severe ROP: (1) baseline model that included gestational age and birth weight, (2) the baseline model adding weight gain, and (3) the baseline model adding change in z score. The area under the receiver operating characteristic curve (C index) was used to compare models. Both weight gain and change in z scores were significant predictors after adjusting for birth weight (P = 0.01) and gestational age (P < 0.01). The C indices were not significantly improved by including weight gain or z score to the baseline model; however, for a subset of subjects, change in weight z score may be a more useful measure compared to simple weight gain with regards to assessing risk for severe ROP.
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http://dx.doi.org/10.1016/j.jaapos.2019.06.007DOI Listing
October 2019

Systemic activation of the complement system in patients with advanced age-related macular degeneration.

Eur J Ophthalmol 2020 Sep 17;30(5):1061-1068. Epub 2019 Jun 17.

Departments of Medicine and Immunology, University of Colorado School of Medicine, Aurora, CO, USA.

Purpose: To examine the role of systemic activation of the complement system (assessed by levels of circulating C3a, Ba, and sC5b-9) in patients (n = 122) with advanced age-related macular degeneration, geographic atrophy, and neovascular age-related macular degeneration, compared with cataract controls (n = 27).

Methods: Plasma complement factors were measured using enzyme-linked immunosorbent assays. Statistical analysis included univariate and multivariate logistic regression (p < 0.05).

Results: Adjusted for age, the odds ratios of C3a and sC5b-9 for any advanced age-related macular degeneration were 1.78 (95% confidence interval = 1.16-2.73, p < 0.01) and 1.20 (95% confidence interval = 1.04-1.39, p = 0.01), respectively. We found a significantly elevated adjusted odds ratio of C3a (adjusted odds ratio = 1.71, 95% confidence interval = 1.12-2.60, p = 0.01) and sC5b-9 (adjusted odds ratio = 1.22, 95% confidence interval = 1.04-1.43, p = 0.01) for neovascular age-related macular degeneration. Adjusted for age, neither C3a, sC5b-9, nor Ba were associated with geographic atrophy.

Conclusion: We suggest a role for elevated plasma levels of C3a and sC5b-9 in patients with neovascular age-related macular degeneration. The study's results reinforce the need for more investigation to assess the impact of therapeutic interventions targeted at the complement signaling pathways in age-related macular degeneration.
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http://dx.doi.org/10.1177/1120672119857896DOI Listing
September 2020

Relationship between severe bronchopulmonary dysplasia and severe retinopathy of prematurity in premature newborns.

J AAPOS 2019 08 24;23(4):209.e1-209.e4. Epub 2019 May 24.

Departments of Ophthalmology, University of Colorado School of Medicine, Aurora.

Background: Bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) are two adverse sequelae of preterm birth associated with abnormal vascular development. The purpose of this study was to characterize the relationship between these two outcomes at a single institution.

Methods: The medical records of infants screened for ROP at the University of Colorado Hospital between January 2012 and December 2017 were reviewed retrospectively. ROP was classified according to Early Treatment Retinopathy of Prematurity (ET-ROP) criteria; BPD, according to the 2010 Criteria from the National Institute for Child Health and Human Development. We examined the relationship between moderate-severe BPD and the development of severe ROP (type 1 or 2) using univariate analysis and multivariable logistic regression with the odds ratio as a measure of association. Covariates included gestational age and birth weight at delivery.

Results: A total of 625 cases were reviewed. Of these, 64 infants (10%) developed severe ROP and 176 (28%) infants developed moderate-severe BPD. We found a significant relationship between these two outcomes following adjustments for gestational age, birth weight, and multiparity (OR = 3.2; 95% CI, 1.6-6.5 [P < 0.01]).

Conclusions: In our cohort of preterm infants, we found a significant relationship between moderate-severe BPD with severe ROP. We hypothesize that these two neonatal outcomes have links with a common pathogenesis.
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http://dx.doi.org/10.1016/j.jaapos.2019.02.008DOI Listing
August 2019

Driving and Visual Acuity in Patients with Age-Related Macular Degeneration.

Ophthalmol Retina 2019 04 17;3(4):336-342. Epub 2018 Nov 17.

Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado.

Purpose: To assess driving status, habitual visual acuity (VA) in the better-seeing eye, and self-reported driving difficulty among patients diagnosed with age-related macular degeneration (AMD).

Design: Cross-sectional cohort study of 553 AMD patients' habitual VA, self-reported driving status, and driving difficulty at time of interview.

Participants: Patients diagnosed with AMD and recruited into the University of Colorado registry.

Methods: Measurement of habitual VA by median logarithm of the minimum angle of resolution (logMAR) and Snellen equivalent, as well as 3 categories: 20/40 or better, 20/50 or 20/60, and worse than 20/60. Driving difficulty was self-reported on the 25-item National Eye Institute Visual Function Questionnaire.

Main Outcome Measures: Self-reported driving status and driving difficulty.

Results: A total of 394 patients (71.2%) reported currently driving at time of study interview. Drivers were significantly younger than nondrivers (mean age, 76.7 years vs. 83.9 years; P < 0.0001) and were more likely to be men (42.6% vs. 25.8%; P = 0.0002). Median habitual VA in the better-seeing eye was better among drivers: 0.097 logMAR (Snellen equivalent, 20/25) versus 0.301 logMAR (Snellen equivalent, 20/40) for nondrivers (P < 0.0001). Among drivers, habitual VA was 20/40 or better for 87.6% of patients, 20/50 to 20/60 for 9.6% of participants, and worse than 20/60 for 2.8% of participants. Driving patients with habitual VA in the better-seeing eye of 20/40 or better reported less difficulty driving compared with patients with 20/50 or worse VA.

Conclusions: In our study, most patients with AMD who were currently driving had at least 20/40 VA in the better-seeing eye. However, 12.4% of patients had VA of 20/50 or worse and reported more difficulties with driving. As the aging population continues to grow with increasing lifespan, the number of patients with AMD will increase, and discussion of driving and VA will become more clinically and legally pertinent.
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http://dx.doi.org/10.1016/j.oret.2018.11.004DOI Listing
April 2019

Risk Factors Associated with Persistent Anterior Uveitis after Cataract Surgery.

Am J Ophthalmol 2019 10 19;206:82-86. Epub 2019 Feb 19.

Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA. Electronic address:

Purpose: To identify risk factors for the development of persistent anterior uveitis (PAU) following uncomplicated phacoemulsification cataract extraction in patients without histories of uveitis or autoimmune diseases.

Design: Retrospective cohort study.

Methods: Medical records were reviewed of patients who underwent phacoemulsification cataract extraction with intraocular lens implantation between January 1, 2014, and December 31, 2016, at the University of Colorado Hospital. Exclusion criteria included patient history of autoimmune disease and/or uveitis, cataract surgery combined with another intraocular surgery, and complicated cataract surgery. Patients with PAU were identified according to Standardization of Uveitis Nomenclature Working Group criteria. Data including sex, race/ethnicity, surgery length and cumulative dissipated energy (CDE), and postoperative visual acuity (VA) and intraocular pressure (IOP) were obtained. Main outcome measurements were risk factors for the development of PAU.

Results: The charts of 3,013 eyes from 2,019 patients were reviewed. A total of 61 eyes (2.0%) from 48 patients developed PAU. African Americans were more likely than whites to develop PAU (relative risk = 11.3; P < 0.0001). Age, sex, surgery length, and CDE were not risk factors. Patients with PAU did not have worse VA than those without PAU, and African Americans with PAU did not have worse VA or IOP than the other races with PAU. Eighteen of the 61 eyes (29.5%) also developed cystoid macular edema.

Conclusions: African Americans have a higher risk of developing PAU after uncomplicated phacoemulsification cataract extraction. The mechanism leading to this is unclear. Although PAU requires prolonged treatment, it does not appear to lead to worse visual outcomes.
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http://dx.doi.org/10.1016/j.ajo.2019.02.016DOI Listing
October 2019
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